Or. Admin. Code § 411-016-0010

Current through Register Vol. 64, No. 1, January 1, 2025

Section 411-016-0010 - Scope of OPI-M Services Case Management

(1) Services Case Managers (SCMs) are responsible for:

(a) Person-centered service plan development including goals, preferences and plan monitoring;

(b) Presenting program options, service options, resources, and alternatives to an individual to assist the individual and their representative in making informed choices and decisions;

(c) Risk assessment and monitoring, including:

(A) Identifying and documenting risks;

(B) Working with an individual to eliminate or reduce risks;

(C) Developing and implementing a Risk Mitigation Plan;

(D) Monitoring risks at least quarterly and more frequently if needed; and

(E) Adjusting an individual's person-centered service plan as needed.

(d) Other program coordination such as helping an individual navigate or coordinate with other social, health, and assistance programs;

(e) Assisting with crisis response and intervention such as participating in problem resolution with an individual or the individual's representative;

(f) Authorizing services to meet the service choices, assessed need and preferences of the individual, considering natural supports and other alternative service resources and service plan related notifications;

(g) Service provision issues such as assisting an individual with problem solving to resolve providers, services or hours issues that do not meet the individual's needs;

(h) Informing individuals of grievance and hearing rights and following grievance and hearing processes.

(i) Documentation of changes in condition, service plan adjustments and reasons for adjustments, service alternatives, completion of required forms and other service plan case management requirements including narration; and,

(j) Completing an Unpaid Caregiver assessment if Community Caregiver Supportive Services or Caregiver Education and Training is requested.

(2) Fiscal Intermediary Responsibilities: SCMs are responsible for the following tasks if fiscal intermediary services are available:

(a) Enrolling the individual into fiscal intermediary services;

(b) Coordinating and reviewing benefit expenditures;

(c) Resolving payment issues with fiscal intermediary; and

(d) Problem solving and monitoring fiscal intermediary services defined in provider contracts.

(3) Case management services must meet the conflict-free case management expectations. When the only willing and qualified provider organization provides both case management and direct services, Department approved firewalls must be in place and followed to ensure a separation of functions within the organization. Conflict-free case management protects against conflicts of interest, fraud and misuse of funding to benefit a provider.

(4) Type B transfer AAA staff serving as OPI-M SCMs may also serve as Eligibility Case Managers as defined OAR 411-014-0005.

Or. Admin. Code § 411-016-0010

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024; APD 64-2024, adopt filed 11/20/2024, effective 11/22/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065